Foundation of Humanistic Nursing Theory
Logic of Phenomenological Methodology
METHODOLOGY-A PROCESS OF BEING
A Heuristic Culmination
Chapter Nine
A Heuristic Culmination
Dr. Paterson wrote this chapter as an example of applying Humanistic theory over time and outcome. The final chapter is a dialogue about her journey in developing her part of humanistic nursing theory. She essentially applied humanistic nursing theory to her own experiences, examined and analyzed how it shaped her theory development.
Dr. Paterson briefly reviewed her nurse work timeline and how the process of developing certain constructs and terms helped her better understand what nursing was to her. The terms comfort, clinical, all-at-once and ambivalence were important for her understanding. Conceptualization of these terms and its relationship with nursing were developed over several years time.
As this struggle subsided I could hear, 'a term could be developed as a concept or synthetic construct if one conceptualized its why, what, how, when and where and how these are interrelated'. (P & Z, p. 98)
Comfort is the why. Clinical is the how. All-At-Once is the what.
Twelve nurse behaviors were gleaned from her clinical data that she viewed as aiding patient comfort.
1. Recognize patients by name with introduction of one's self.
2. Educate and convey honest information about patient's situation.
3. Verbalize patients' expressions of feeling and acceptance of same when appropriate with an explanation.
4. Stay with or do for patient when verbalization of acceptance is not appropriate.
5. Purposely express authentic tender feelings when acceptable and appropriate.
6. Support Agape-type love relationships.
7. Allow patient's choices as current capabilities allowed that in turn showed respect for patient and their rights.
8. Assist patients understanding of current expressed feelings and behaviors in light of past life experiences and patterns and compare and contrast these to the now.
9. Patient expression to facilitate understanding of behavioral messages and respond therapeutically.
10. Verify intuition of perceptions with questions, comments and responses.
11. Realistically encourage hope through discussion.
12. Encourage and supported appropriate self-images.
These behaviors were derived from a psychiatric setting. With behaviors done to encourage comfort, she turned to the discomfort-comfort side of the equation. Here again, with clinical data, she found four behaviorally recognizable criteria that contributed to the discomfort-comfort state. This criteria can be scaled and from the absence of this criteria it may be inferred that discomfort exists. The criteria included the following:
1. Relationships with other persons which confirm one as an existent important person.
2. Affective adaptation to the environment in accord with knowledge potential and values.
3. Awareness of and response to the reality of the now with understanding of the influence of and separation from the past.
4. Appreciation and recognition of both powers and limitations which enlighten the alternatives of the future. (P & Z, p. 100)
Dr. Paterson's construct of comfort resulted in this summation:
Comfort is an aim toward which persons' conditions of being move through relationship with others by internalizing freedom from painful controlling effects of the past. These effects have inhibited their self-control, realistic planning, and prevented them from being all that they could be in accordance with their potential at any particular time in any particular situation. (P & Z, p. 103)
Comfort is the why.
Dr. Paterson turned to the term "clinical" after much resistance on her part in construct development having overcome this initial reluctance with comfort. She conceptualized that it was in the clinical that the how of working towards comfort was derived. It is in the clinical that experiencing occurs and being purposely aware, then recalling, pondering, sorting out and coming to know. She wrote of her own feelings and experiences in coming to this conclusion.
"Two clinical consultation experiences were juxtaposed, contrasted questioned, related and synthesized to envision their unified contribution to the construct of 'clinical'. (P & Z, p.107) After this was done Dr. Paterson wrote that a situation is not a 'clinical' experience until reflection, analyzation, categorization has been done and it is incorporated and synthesized in the psychiatric mental health situation.
Relating in 'I-Thou' with the other in-his-clinical-world the clinician gives of himself and receives back the other and himself in the sphere of 'the between'. He knows the other and the more of himself in this relating. He is confirmed and confirms the other through the other's presence with him. Thus, He calls forth the other's actualizing of self through the clinical relationship. In accepting the other as he is the clinician imagines and responds to the reality of his potential for becoming, becoming according to his unique capacity for humanness.
Relating in 'I-It' with his clinical world the clinician noetically transcends himself, objectifies himself, and studies his 'I-Thou' knowing. He teases it apart. He classifies and studies it. He asks it questions. He compares and contrasts it to other clinical experiences. He discusses its many aspects in dialogue with his 'inward,' and possibly 'outward' 'Thous.' He reorders its parts. He shapes, creates, plans from and for its clinical existence. Thus He ever augments a world of heuristic knowing". (P & Z, p. 108-09)
In doing the above "how" Dr. Paterson received fulfillment in clinical nursing and which resulted in her knowing "why" she is was a nurse in the health-nursing situation. Clinical is the how. She then turned her thoughts to "what" was the nature of the nurse's work.
Paterson decided on the term "all-at-once" would be the best fit for describing the "multifarious multiplicities that exist within nursing situations". (P & Z, p.109) Multitasking comes to this author's mind when reading Dr. Paterson's examples. She wrote that the nature of nursing is complex and while constructs that are simple worked, due to the nature of nursing, simple constructs would not apply to every situation. She wrote that frequently nurses utilize and need further development of duality in their mode of being. This is where the nurse needs to be fully aware of and engaged in multiple stimuli and have a "highly developed capacity for living the 'all-at-once' in and with the flow of the multifarious multiplicities of their worlds" . (P & Z, p. 111) This construct allowed her to convey how she experiences the health nursing situation.
All-At-Once is the what.
Dr. Paterson summarized this chapter and book with the following:
Humanistic nursing practice theory in asking for phenomenological descriptions of the nurse's lived-world of experiencing proposes authentic awareness with the self of what is existent in the situation prior to conceptualization for dispersal. Unless nurses appreciate and give recognition to the dynamic meaningful breadth, depth, and future influence of their worlds the actualization of the potential thrust of the nursing professional will never be or become. (P & Z, p. 111)
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